Journal of Anesthesia & Clinical

Research Alnour et al., J Anesth Clin Res 2015, 6:9

http://dx.doi.org/10.4172/2155-6148.1000560

Research Article Open Access

Comparison between the Side Effects of Spinal and General Anesthesia during
Caesarean Section in Tripoli-Libya
Tarig MS Alnour1*, Amjad T Shaktur2,3, Radwan A Ayyad3, Masoda M Alhewat3, Enas H Shaban3, Hoda A Mohamed3 and Abderahman A Abdelfatah3
1Department of Medical Laboratory Technology, Faculty of Medical Technology, AlMergib University, Libya 2Department of Intensive Care and Anesthesia, Faculty of
Medical Technology, Tripoli University, Libya
3Department of Anesthesia and Intensive Care, Faculty of Medical Technology, AlMergib University, Libya

*Corresponding author: Alnour MST, Department of Medical Laboratory Technology, Faculty of Medical Technology, AlMergib University, Libya, Tel: +249900634333;
E-mail: tarigms@yahoo.com
Received date: Jul 02, 2015; Accepted date: Aug 28, 2015; Published date: Aug 31, 2015
Copyright: © 2015 Alnour MST, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Aim of the study: The present study was aimed to compare the side effects of general vs spinal anesthesia
during caesarean operation.

Materials and methods: This study was conducted on 50 randomly selected participants. Of them 25
participants referred as case group A (treated with general anesthesia), and 25 participants were referred as case
group B (treated with spinal anesthesia). Blood samples were collected before and after the operation to see the
differences in WBCs, RBCs, Hemoglobin concentration and platelets count. Blood pressure and body temperature
were also measured after operation. Other parameters were collected from patient's thick report or by direct
interviewing questionnaire.

Results: The mean age of the participants was 30.52 ± 4.608, majority of them have their first or second
caesarean section. 23/25 (92%) of spinal anesthesia was decided with the doctor while 20/25 (80%) of general
anesthesia was chosen the patient's themselves. Local pain and headache were clearly observed in spinal
anesthesia while vomiting, fever, ICU admission and infection were very rare when using both types of anesthesia.
Marked differences were observed in the hemoglobin concentration, RBCs count, WBCs count and platelets count
when using the two techniques of anesthesia before and after operation.

In our study, we observed in 40% of participants suffered from pain and 34% suffered from headache after
operation in both groups A and B. No remarkable difference was noted on blood pressure range (but some
participants have slightly decrease in BP). All participants have slight changes in WBCs, platelets count, RBCs count
and Hemoglobin concentration.

Conclusion: Differences were observed in the tested parameters between general and spinal anesthesia, and
the decision for types of anesthesia was made according to patient's psychological behavior rather that her medical
condition.

Keywords: Spinal anesthesia; Side effects; General anesthesia;
Hemoglobin; Rbcs; Platelets; Wbcs
Introduction
Over the past few decades, there has been a tremendous increase in
the number of cesarean deliveries performed by section in most
industrialized countries. Wide differences occur between countries,
regions or even hospitals within the same region with similar
socioeconomic profiles and patient characteristics [1]. This suggests
that cesarean section (CS) is probably often performed for non-
medical reasons leading to an overall overuse of this surgical obstetric
intervention. Indeed, it has been acknowledged that elective primary
and repeat CS have contributed heavily to the rise in CS [2]. In the US,
for instance, the overall CS rates increased by 14% from 1998 to 2001
as a result of a 13% increase in medically indicated primary CS and a
53% increase in the rate of elective primary CS [3]. Because of this
global increase in CS rates, more attention is being paid to their
outcomes. Spinal, epidural or general anesthesias (GA) are the
methods of choice for CS delivery. Both methods have advantages and
disadvantages. Although regional anesthesia is the primary choice in
most countries, it is still controversial in some aspects. There is also a
great difference between countries, regions or even hospitals regarding
the preference for the method of anesthesia. In a study held at a
university hospital in Turkey, only 44.5% of patients were
preferentially submitted to regional anesthesia [4], as opposed to an
80% rate in the US [5].
The purpose of the anesthetic is to reduce the pain that developed
during caesarean section operation. This can be achieved using a
general anesthetic, a spinal anesthetic or an epidural anesthetic. There
are times when these techniques may be used together [6].
General anesthesia is given using a combination of drugs that are
injected into the mother and gases that mother breathe. It is used to
make the mother unconscious in a carefully controlled way. General
anesthesia has been shown to be very safe although it's less commonly
performed than epidural or spinal anesthetics for caesarean section
[7].

J Anesth Clin Res Volume 6 • Issue 9 • 1000560

ISSN:2155-6148 JACR, an open access journal
Citation: Alnour TM, Shaktur AT, Ayyad RA, Alhewat MM, Shaban EH, et al. (2015) Comparison between the Side Effects of Spinal and General
Anesthesia during Caesarean Section in Tripoli-Libya. J Anesth Clin Res 6: 560. doi:10.4172/2155-6148.1000560

Page 2 of 4

Spinal anesthetics are usually used as a single injection of local Results

anesthetic for an operation. The single injection lasts for 2-3 hours
Spinal anesthetics are more commonly chosen for caesarean section,
because they block the nerves more completely and more rapidly than
an epidural [8]. The aim of this study is to compare the side effects of
general vs spinal anesthesia during caesarian operation.
Patients and Methods
This study was conducted in Tripoli - Libyan, between the period
from December 2014 and June 2015. The study covers 50 participants
divided into two groups. Group (A) were 25 females with caesarean
section who subjected to general anesthesia and Group B were 25
females with caesarean section who subjected to spinal anesthesia. All
participants were selected randomly despite their age, clinical
condition or nationality.
Blood samples were collected by vein puncture prior and after the
operation, hemoglobin concentration (Hb), red blood cells (RBCs),
white blood cells (WBCs) and platelets (Plts) count were measured
using Sysmex Kx21 and data were recorded. Blood pressure and body
temperature were measured using sphygmomanometer and
thermometer, respectively after the operation. Other data include age,
type of anesthesia used, the decision to choose types of anesthesia
made by whom?, number of previous caesarean section(s), presence of
side effects after operation which includes: pain, headache and
vomiting were collected using direct constructed questionnaire and
from patient's clinical record.
Ethical consideration
Ethical approval was submitted from participants who approved to
sign consent of approval to participate in this study. The proposal of
this research was submitted and approved by the ethical committee of
the faculty of Medical Technology-AlMergib Univeristy.
A total of 50 participants who come for caesarean section were
evaluated in this study, 25 with general anesthesia and 25 with spinal
anesthesia. The mean age of participants was 30.5 years old with a
range between 20-38 years. The mean age of participants with spinal
anesthesia was 30.32 while for participants with general anesthesia was
30.72. The majority of caesarean sections with general anesthesia
(20/25) were decided by patients themselves, most of them on their
first delivery operation, while the majority of caesarean sections with
spinal anesthesia (23/25) were decided by Doctors (Figure 1).
Mild side effects were noted on participants with spinal anesthesia
which include vomiting, headache, localized pain and hypotension
(Figure 2). All participants enrolled in this study had No infection
after operation while 2 participants with spinal anesthesia had
complications which required ICU admission compared to just one
participant having general anesthesia. The complication in all cases
due to hypotension (Figure 2).
Slight increases were noted in the mean of WBCs count after
operation with marked increases among participants who had general
anesthesia. The mean of red blood cells (RBCs) count, Hemoglobin
concentration and platelets count were decreased after caesarean
section with marked decrease in the mean to participants with general
anesthesia (Table 1).
No remarkable difference was noted between the mean of systolic
and diastolic blood pressure for both participants with spinal
anesthesia and general anesthesia (Table 1).
Significant correlation was noted between the mean of TWBCs after
operation and platelets count before operation (P value=0.011 and
0.035, respectively).

Variable Before operation P value After operation P value

(mean ± SD) (mean ± SD)

General anesthesia Spinal anesthesia General Spinal anesthesia

anesthesia

TWBCs (× 109/L) 9.78 ± 2.514 9.86 ± 2.478 0.714 11.676 ± 2.91 10.29 ± 2.464 0.011*

RBCs (× 1012/L) 4.07 ± 0.317 4.11 ± 0.345 0.499 3.71 ± 0.421 3.86 ± 0.306 0.363

Hemoglobin (g/L) 12.33 ± 3.477 11.35 ± 1.792 0.868 10.63 ± 1.63 10.72 ± 1.501 0.674

Platelets count (× 206.08 ± 80.235 185.4 ± 40.234 0.035* 196.28 ± 56.523 174.8 ± 46.377 0.308
109/L)

Systolic blood ND ND ND 111.88 ± 14.712 110.92 ± 20.093 0.67

pressure (mmHg)

Diastolic blood ND ND ND 68.28 ± 10.706 65.6 ± 13.048 0.862

pressure (mmHg)

*Correlation is significant at the 0.05 level (2-tailed); **ND: Not Done

Table 1: Difference in the mean ±SD between participants subjected to spinal and general anesthesia before and after the caesarean section.

J Anesth Clin Res Volume 6 • Issue 9 • 1000560

ISSN:2155-6148 JACR, an open access journal
Citation: Alnour TM, Shaktur AT, Ayyad RA, Alhewat MM, Shaban EH, et al. (2015) Comparison between the Side Effects of Spinal and General
Anesthesia during Caesarean Section in Tripoli-Libya. J Anesth Clin Res 6: 560. doi:10.4172/2155-6148.1000560
Figure 1: Number of participants who had previous caesarean
section (Chi square = 23.4, P value = 0.285).
Figure 2: Side effects associated with the two types of anesthesia
(general and spinal anesthesia).
Discussion
The majority of general anesthesia was decided by the patient's
themselves. It is normal to feel pressure and pulling during a caesarean
section operation. There is a lot of individual variation in people's size
and shape and requirements for local anesthetic. It is not always
possible for the anesthetist to put in a spinal. This can also result in the
need to have a general anesthetic [9]. The majority of females with
caesarean section who had their first delivery operation was subjected
to general anesthesia while spinal anesthesia was increased after first
CS and starts to decrease regularly, this might be due to that on first
caesarean the patient's believe spinal anesthesia might affects their
movement or may leads to paralysis.
All participants with spinal anesthesia have no fever while few of
general anesthesia participants have fever, this might be due to
unclean caesarean rather than due to the mode of administration of
anesthesia. Infections are extremely rare, so rare that it is not possible
to give an accurate incidence. All of the spinal needles, catheters, local
anesthetics, intravenous drips, syringe, tubing and fluids are sterile and
for single use only. The anesthetist uses a sterile technique to insert the
spinal. However, it is not possible to totally eliminate the risk of
infection at the injection site or around the spinal cord (causing
meningitis or an abscess) [10].
J Anesth Clin Res
ISSN:2155-6148 JACR, an open access journal
Page 3 of 4
A prolonged drop in maternal blood pressure has the potential to
reduce blood flow to the baby. During the spinal anesthetic the blood
pressure is monitored carefully by the anesthetist and treated readily to
prevent potential problems for the baby. In this study decrease in
blood pressure after operation was observed in some cases in both
groups A and B, although there was no remarkable difference between
the mean of systolic and diastolic blood pressure for both groups.
Low back pain is common after spinal injection, but is expected to
resolve within 2 weeks [11]. In this study, pain was observed in both
groups.
A specific type of headache, called a post spinal headache, can occur
after spinal injection. This headache can be mild or severe and usually
resolves spontaneously over 1-3 weeks [12]. In this study, headache
was observed in both groups A (general anesthesia) and B (spinal
anesthesia), but increased in group B. This result proves that patients
receiving general anesthesia are much easier to suffer headache than
the patients receiving spinal anesthesia. It is also important to
understand that there are many other causes of headache that are more
common. It is also possible to experience temporary deafness
following spinal anesthetic [13]. In some patients in our study, they
had it.
White blood count (WBCs) was markedly increased among
participants with general anesthesia. This might be due to the general
side effects of general anesthesia due to its direct introduction to the
blood. Slight increases in WBCs count was observed in two groups,
several studies on the effects of different anesthetic agents on WBCs
count stated that some anesthetic agents increase the WBCs count
[14-16].
Red blood cells (RBCs) count was decreased after caesarean section;
this result is similar to the result of Ismail et al [16]. Marked decrease
in the mean of RBCs count was noted in participants with general
anesthesia, this also might be due to the effects of direct introduction
of anesthetic agents to the blood.
Conclusion
Although it seems to be safer, spinal anesthesia has mild side effects
such as vomiting, head ache and local pain. In contrast general
anesthesia may affect hematological parameters by increasing the
WBCs count and decreasing hemoglobin concentration, RBCs count
and platelets count. So it is highly recommended to leave the decision
of type of anesthesia to the doctor upon patients' clinical condition.
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Volume 6 • Issue 9 • 1000560
Citation: Alnour TM, Shaktur AT, Ayyad RA, Alhewat MM, Shaban EH, et al. (2015) Comparison between the Side Effects of Spinal and General
Anesthesia during Caesarean Section in Tripoli-Libya. J Anesth Clin Res 6: 560. doi:10.4172/2155-6148.1000560
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